Praava Health: Family Doctors & Diagnostics

Praava seeks to restore dignity and trust in a broken healthcare system. Currently, doctors in Bangladesh spend an average of 48 seconds with each patient, and are financially incentivized to prescribe unnecessary treatments and procedures. With only one accredited lab in the country, patients might send four tests to four labs and receive four different results. All of this coalesces into a deep distrust of the healthcare system and a mass exodus of patients to clinics abroad. 

We built a one-stop-shop where patients get quality time with doctors, gold-standard diagnostic tests and quality prescriptions -- all for a flat fee that Bangladeshi families can afford. We are using technology in a way no other health facility has in Bangladesh, all in an effort to create seamless patient experiences. We are the first value-based care model in the country that has the potential to transform the way Bangladeshis get care.

While health care interventions continue to focus on the rural and ultra poor, 40 million Bangladeshis are emerging out of poverty into the middle class and struggling to find quality, local healthcare they trust. Despite a rapidly growing economy and great strides improving health in Bangladesh, urban healthcare is still largely unreliable.

On average, a consultation with a doctor lasts 48 seconds. Billing is typically fee-for-service and there are direct financial incentivizes for physicians to overprescribe drugs and tests and keep patients in the hospital. Since Bangladesh has only one internationally-accredited lab, lab results are often incorrect or inconsistent from lab to lab. If a patient does get an accurate result, they likely cannot trust the drugs prescribed to them: 10% of medication in the market is counterfeit and there are 200,000 unlicensed pharmacies in the country.

This has resulted in deep distrust in the healthcare system, compelling patients to seek care abroad (up to 2,000 medical visas are issued daily to India alone). This is a huge expense to newly middle class families, risking pushing them back into poverty. Thus, the next healthcare crisis in Bangladesh will not be among the poorest - it will be the middle class. 

Praava serves the “missing middle“ – the urban middle class that has lost trust in local care and is both neglected by public aid and struggling to afford care abroad. This urban middle class is significant – doubling in the last decade to 40 million  – and largely uninsured. They often suffer from chronic diseases like diabetes and hypertension, accustomed to Bangladesh’s hospital-centric model that addresses their condition too late. They carry their records from hospital to hospital in bags, without any continuity of care. 

Around four years ago, Praava’s Founder and CEO Sylvana Sinha personally experienced the failures of local healthcare and went on a global ‘listening tour’ to understand the sector’s major challenges. After speaking with patients, healthcare professionals and diverse providers, patients and other professionals across Bangladesh, Southeast Asia, and globally, Sylvana discovered a fundamental power imbalance between physicians and patients. She resolved to create a new model that prioritized and empowered patients with holistic, quality care, and accurate diagnostics where every patient is treated with dignity. Praava meets this urban middle class’s healthcare needs by providing care that is affordable, equitable, and transparent. 

Praava is a one-stop shop for unprecedented levels of quality, patient-centric care. In a country where healthcare is highly transactional and hospital-centric, we’re flipping healthcare delivery on its head. We’re building a value-based outpatient facility driven by patient outcomes and quality, not volume. Our doctors spend 15 minutes with patients, focusing on patient education, prevention and wellness. This enables more personal and empathetic patient-doctor relationships, creating a continuity of care over time.

To ensure quality, Praava also invested across the diagnostics spectrum – with an in-house laboratory, pharmacy, imaging and select outpatient procedures. The laboratory was set up to align with international quality standards and protocols, continually cross-checking results with international labs on a monthly basis (including the College of American Pathologists proficiency tests and UK’s regulatory body). We use barcoding and a pneumatic tube system that sends samples directly from phlebotomy to the laboratory to minimize errors. We also invested in our own pharmacy to personally procure all drugs directly from top manufacturers and minimize the risk of fraudulent or substandard drugs, securing “model pharmacy” status -- one of only 600 in the country.

We align our business model and incentives with patient values. Since only 1% of Bangladeshis have insurance, our membership model allows patients to access doctors as much as they like for a flat annual fee -- incentivizing doctors to keep patients healthy, and empowering patients to seek preventative care and proactively manage existing chronic conditions. We are the first health facility to step up and provide this type of outpatient insurance in Bangladesh.

We’re also rethinking how technology can transform a doctor visit and set up several tech-enabled solutions to streamline the entire patient journey. We host the country’s first fully-integrated electronic record system and patient portal. This app allows patients to book appointments, access medical records and review prescriptions from the convenience of their home. Having patients’ medical records in one place allows doctors to access patient histories so patients don’t need to update their doctor each time they visit -- and they can stop dragging their records around in bags. 

We are currently serving 16,000 patients and are constantly evaluating patient feedback to improve our business model. One patient wrote in survey feedback: “Praava Health feels like the Apple store of healthcare in Dhaka!“  As we say at Praava, regardless of who walks in the door,  “we care for you like family.”  

The short answer: no one else is doing what we’re doing. We offer an unrivaled experience with internationally trained family doctors, diagnostics and imaging services that are up to global standards, the country’s first molecular cancer diagnostics lab and a tech-integrated patient experience (including the first online patient portal in Bangladesh). We also are using a value-based membership model that treats patients like people, not dollar signs. 

Our patients get more time with doctors, can receive all their health services in one place, and receive diagnostic tests they can trust -- all for an affordable annual fee. This makes them more likely to go to the doctor and prevent diseases before they occur (or manage chronic illnesses and prevent them from worsening). By using a membership model enabled by cutting-edge technology, we're taking the financial guesswork out of going to the doctor and preventing middle class families from falling back into poverty when a family member is ill.

We currently serve 20,000 patients in Dhaka at our flagship facility. In one year, we predict we will reach 40-50,000 people by expanding to 5 satellite clinics, or "spokes." In the next five years, we will expand to Chittagong with a total of 27 clinics - hoping to reach 1 million people. 

Within the next year, we intend to launch 5 new spokes -- or satellite clinics and pharmacies -- to extend the reach our hub in Dhaka. We also aim to expand the capacity of our molecular cancer diagnostics lab so that more Bangladeshis can access this cutting-edge technology and improve their odds of beating cancer. We also aim to develop a proprietary hospital information system and our patient portal capabilities; the future online-to-offline opportunity will grow exponentially as Praava expands its brick-and-click model, and connectivity and smartphone usage continues to expand. We will also invest in talent and training so that we can build a top-quality health care network that patients can trust. By 2027, we aim to have 35 clinics in Dhaka and Chittagong.

Our multicultural and diverse solution team comprises of medical professionals and patient caregivers, along with a team of experts in operations, business innovations, marketing, IT, and others in the corporate office, totaling 210 employees. We have 19 family health professionals which include family doctors. Our lab team has 30 members and our corporate office has 49 employees. We are also proud to share that 50% of our management team is female. 

Our international partnerships include the Joslin Diabetes Center at Harvard Medical School; Lifetrack Medical Systems to input on radiology scans; and Narayana Health to offer patients video consultations with over 30 specialists at Narayana.

As online-to-offline opportunities grow and connectivity and smartphone usage continues to expand, Praava will need to expand its brick-and-click model, investing more in our patient portal and online systems. If we are selected, the Tiger IT Foundation would enable us to embed more design thinking into our work and formalize training in that area for our staff. This will be crucial as we design more tech-based solutions to health care problems.

Being part of the Solve community will also help us engage with partners that have tech expertise and can help us think creatively about developing improved patient experiences through technology. 

We would like to deepen our partnerships with top medical and engineering schools in the US, including MIT, Harvard and Columbia, and work with students who are innovating in health  delivery systems and technology.